THE HARBORS ASSISTED & INDEPENDENT LIVING EMPLOYMENT APPLICATION
The Harbors Assisted & Independent Living is an equal opportunity employer. This application will not be used for limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Applicants requiring reasonable accommodation in the application and/or interview process should notify a representative of the organization.
* Required
First Name
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Your answer
Last Name
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Your answer
Email Address
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Your answer
Phone Number
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Your answer
Mailing Address
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Your answer
Are you over the age of 18?
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Yes
No
What is your availability?
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Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Required
If hired, when would you be able to start working?
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MM
/
DD
/
YYYY
Can you work weekends?
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Yes
No
Can you work nights?
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Yes
No
Required
Are you willing to perform a background check?
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Yes
No
Have you ever worked for The Harbors Assisted & Independent Living?
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Yes
No
Do you have any friends, relatives or acquaintances working for The Harbors Assisted & Independent Living?
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Yes
No
Do you have reliable transportation?
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Yes
No
Are you able to perform the functions of the job for which you are applying for, either with or without reasonable accommodation?
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Yes
No
If you answered "No" to the above then please describe the functions that you would not be able to perform:
Your answer
Are you willing to pick up shifts and cover for others shifts?
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Yes
No
Have you ever been convicted of a crime?
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Yes
No
If you answer "Yes" please explain:
Your answer
Are you willing to work Holidays?
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Yes
No
If hired, are you willing to submit to a drug test and TB test before you start your employment?
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Yes
No
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